1
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Barnes KG, Levy JI, Gauld J, Rigby J, Kanjerwa O, Uzzell CB, Chilupsya C, Anscombe C, Tomkins-Tinch C, Mbeti O, Cairns E, Thole H, McSweeney S, Chibwana MG, Ashton PM, Jere KC, Meschke JS, Diggle P, Cornick J, Chilima B, Jambo K, Andersen KG, Kawalazira G, Paterson S, Nyirenda TS, Feasey N. Utilizing river and wastewater as a SARS-CoV-2 surveillance tool in settings with limited formal sewage systems. Nat Commun 2023; 14:7883. [PMID: 38036496 PMCID: PMC10689440 DOI: 10.1038/s41467-023-43047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
The COVID-19 pandemic has profoundly impacted health systems globally and robust surveillance has been critical for pandemic control, however not all countries can currently sustain community pathogen surveillance programs. Wastewater surveillance has proven valuable in high-income settings, but less is known about the utility of water surveillance of pathogens in low-income countries. Here we show how wastewater surveillance of SAR-CoV-2 can be used to identify temporal changes and help determine circulating variants quickly. In Malawi, a country with limited community-based COVID-19 testing capacity, we explore the utility of rivers and wastewater for SARS-CoV-2 surveillance. From May 2020-May 2022, we collect water from up to 112 river or defunct wastewater treatment plant sites, detecting SARS-CoV-2 in 8.3% of samples. Peak SARS-CoV-2 detection in water samples predate peaks in clinical cases. Sequencing of water samples identified the Beta, Delta, and Omicron variants, with Delta and Omicron detected well in advance of detection in patients. Our work highlights how wastewater can be used to detect emerging waves, identify variants of concern, and provide an early warning system in settings with no formal sewage systems.
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Affiliation(s)
- Kayla G Barnes
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Joshua I Levy
- Department of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jillian Gauld
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Jonathan Rigby
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Oscar Kanjerwa
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Christopher B Uzzell
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chisomo Chilupsya
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Catherine Anscombe
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Christopher Tomkins-Tinch
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Omar Mbeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | | | - Herbert Thole
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Shannon McSweeney
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Marah G Chibwana
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Philip M Ashton
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre District Health Office, Blantyre, Malawi
| | - Khuzwayo C Jere
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre District Health Office, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - John Scott Meschke
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Peter Diggle
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jennifer Cornick
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre District Health Office, Blantyre, Malawi
| | - Benjamin Chilima
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
- Public Health Institute of Malawi, Lilongwe, Malawi
| | - Kristian G Andersen
- Department of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Gift Kawalazira
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | | | - Tonney S Nyirenda
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA
- School of Medicine, University of St Andrews, St Andrews, UK
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2
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Shaw AG, Troman C, Akello JO, O'Reilly KM, Gauld J, Grow S, Grassly N, Steele D, Blazes D, Kumar S. Defining a research agenda for environmental wastewater surveillance of pathogens. Nat Med 2023; 29:2155-2157. [PMID: 37537374 DOI: 10.1038/s41591-023-02457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Alexander G Shaw
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Catherine Troman
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Joyce Odeke Akello
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Kathleen M O'Reilly
- Centre for Mathematical Modeling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Nicholas Grassly
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - David Blazes
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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3
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Wong W, Gauld J, Famulare M. From vaccine to pathogen: Modeling Sabin 2 vaccine virus reversion and evolutionary epidemiology in Matlab, Bangladesh. Virus Evol 2023; 9:vead044. [PMID: 37692896 PMCID: PMC10491863 DOI: 10.1093/ve/vead044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023] Open
Abstract
The oral poliovirus vaccines (OPVs) are one of the most effective disease eradication tools in public health. However, the OPV strains are genetically unstable and can cause outbreaks of circulating, vaccine-derived Type 2 poliovirus (cVDPV2) that are clinically indistinguishable from wild poliovirus (WPV) outbreaks. Here, we developed a Sabin 2 reversion model that simulates the reversion of Sabin 2 to reacquire a WPV-like phenotype based on the clinical differences in shedding duration and infectiousness between individuals vaccinated with Sabin 2 and those infected with WPV. Genetic reversion is informed by a canonical reversion pathway defined by three gatekeeper mutations (A481G, U2909C, and U398C) and the accumulation of deleterious nonsynonymous mutations. Our model captures essential aspects of both phenotypic and molecular evolution and simulates transmission using a multiscale transmission model that consolidates the relationships among immunity, susceptibility, and transmission risk. Despite rapid Sabin 2 attenuation reversal, we show that the emergence of a revertant virus does not guarantee a cVDPV2 outbreak. When simulating outbreaks in Matlab, Bangladesh, we found that cVDPV2 outbreaks are most likely in areas with low population-level immunity and poor sanitation. In Matlab, our model predicted that declining immunity against Type 2 poliovirus following the cessation of routine OPV vaccination was not enough to promote cVDPV2 emergence. However, cVDPV2 emergencedepended on the average viral exposure dose per contact, which was modeled as a combination of the viral concentration per fecal gram and the average fecal-oral dose per contact. These results suggest that cVDPV2 emergence risk can be mitigated by reducing the amount of infectious fecal material individuals are exposed to. Thus, a combined strategy of assessing and improving sanitation levels in conjunction with high-coverage vaccination campaigns could limit the future cVDPV2 emergence.
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Affiliation(s)
- Wesley Wong
- Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, SPH 1, Boston, MA 02115, USA
| | - Jillian Gauld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
| | - Michael Famulare
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA
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4
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Ng'eno E, Lind M, Audi A, Ouma A, Oduor C, Munywoki PK, Agogo GO, Odongo G, Kiplangat S, Wamola N, Osita MP, Mugoh R, Ochieng C, Omballa V, Mogeni OD, Mikoleit M, Fields BS, Montgomery JM, Gauld J, Breiman RF, Juma B, Hunsperger E, Widdowson MA, Bigogo G, Mintz ED, Verani JR. Dynamic Incidence of Typhoid Fever over a 10-Year Period (2010-2019) in Kibera, an Urban Informal Settlement in Nairobi, Kenya. Am J Trop Med Hyg 2023:tpmd220736. [PMID: 37253442 DOI: 10.4269/ajtmh.22-0736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
Typhoid fever burden can vary over time. Long-term data can inform prevention strategies; however, such data are lacking in many African settings. We reexamined typhoid fever incidence and antimicrobial resistance (AMR) over a 10-year period in Kibera, a densely populated urban informal settlement where a high burden has been previously described. We used data from the Population Based Infectious Diseases Surveillance platform to estimate crude and adjusted incidence rates and prevalence of AMR in nearly 26,000 individuals of all ages. Demographic and healthcare-seeking information was collected through household visits. Blood cultures were processed for patients with acute fever or lower respiratory infection. Between 2010 and 2019, 16,437 participants were eligible for blood culture and 11,848 (72.1%) had a culture performed. Among 11,417 noncontaminated cultures (96.4%), 237 grew Salmonella enterica serovar Typhi (2.1%). Overall crude and adjusted incidences were 95 and 188 cases per 100,000 person-years of observation (pyo), respectively. Annual crude incidence varied from 144 to 233 between 2010 and 2012 and from 9 to 55 between 2013 and 2018 and reached 130 per 100,000 pyo in 2019. Children 5-9 years old had the highest overall incidence (crude, 208; adjusted, 359 per 100,000 pyo). Among isolates tested, 156 of 217 were multidrug resistant (resistant to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole [71.9%]) and 6 of 223 were resistant to ciprofloxacin (2.7%). Typhoid fever incidence resurged in 2019 after a prolonged period of low rates, with the highest incidence among children. Typhoid fever control measures, including vaccines, could reduce morbidity in this setting.
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Affiliation(s)
- Eric Ng'eno
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Lind
- Institute for Disease Modelling, Seattle, Washington
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Allan Audi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clifford Oduor
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick K Munywoki
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George O Agogo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George Odongo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel Kiplangat
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Newton Wamola
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mike Powel Osita
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Mugoh
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Caroline Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Omballa
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Epidemiology, Public Health and Impact Unit, International Vaccine Institute, Seoul, South Korea
| | | | - Barry S Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jillian Gauld
- Institute for Disease Modelling, Seattle, Washington
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bonventure Juma
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric D Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Barnes K, Levy J, Andersen K, Gauld J, Rigby J, Kanjerwa O, Uzzell C, Chilupsya C, Anscombe C, Tomkins-Tinch C, Mbeti O, Cairns E, Thole H, McSweeney S, Chibwana M, Ashton P, Jere K, Meschke J, Diggle P, Cornick J, Jambo K, Kawalazira G, Paterson S, Nyirenda T, Feasey N, Chilima B. Utilizing river and wastewater as a SARS-CoV-2 surveillance tool to predict trends and identify variants of concern in settings with limited formal sewage systems. Res Sq 2023:rs.3.rs-2801767. [PMID: 37090541 PMCID: PMC10120776 DOI: 10.21203/rs.3.rs-2801767/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The COVID-19 pandemic continues to impact health systems globally and robust surveillance is critical for pandemic control, however not all countries can sustain community surveillance programs. Wastewater surveillance has proven valuable in high-income settings, but little is known about how river and informal sewage in low-income countries can be used for environmental surveillance of SARS-CoV-2. In Malawi, a country with limited community-based COVID-19 testing capacity, we explored the utility of rivers and wastewater for SARS-CoV-2 surveillance. From May 2020 - January 2022, we collected water from up to 112 river or informal sewage sites/month, detecting SARS-CoV-2 in 8.3% of samples. Peak SARS-CoV-2 detection in water samples predated peaks in clinical cases. Sequencing of water samples identified the Beta, Delta, and Omicron variants, with Delta and Omicron detected well in advance of detection in patients. Our work highlights wastewater can be used for detecting emerging waves, identifying variants of concern and function as an early warning system in settings with no formal sewage systems.
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Affiliation(s)
| | | | - Kristian Andersen
- Department of Immunology and Microbiology The Scripps Research Institute La Jolla CA USA
| | - Jillian Gauld
- Institute for Disease Modeling, Bill & Melinda Gates Foundation
| | - Jonathan Rigby
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Oscar Kanjerwa
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Chisomo Chilupsya
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | - Edward Cairns
- Department of Evolution, Ecology and Behaviour, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool
| | - Herbert Thole
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences
| | - Shannon McSweeney
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Marah Chibwana
- Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences
| | | | | | | | | | - Jennifer Cornick
- Department of Evolution, Ecology and Behaviour, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool
| | | | | | | | - Tonney Nyirenda
- Department of Pathology, Kamuzu University of Health Sciences
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6
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Hagedorn B, Zhou NA, Fagnant-Sperati CS, Shirai JH, Gauld J, Wang Y, Boyle DS, Meschke JS. Estimates of the cost to build a stand-alone environmental surveillance system for typhoid in low- and middle-income countries. PLOS Glob Public Health 2023; 3:e0001074. [PMID: 36962955 PMCID: PMC10021573 DOI: 10.1371/journal.pgph.0001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/02/2022] [Indexed: 01/27/2023]
Abstract
The typhoid conjugate vaccine is a safe and effective method for preventing Salmonella enterica serovar Typhi (typhoid) and the WHO's guidance supports its use in locations with ongoing transmission. However, many countries lack a robust clinical surveillance system, making it challenging to determine where to use the vaccine. Environmental surveillance is one alternative approach to identify ongoing transmission, but the cost to implement such a strategy is previously unknown. This paper estimated the cost of setting up and operating an environmental surveillance program for thirteen protocols that are in development, including thirteen cost components and twenty-seven pieces of equipment. Unit costs were obtained from research labs involved in protocol development and equipment information was obtained from manufacturers and the expert opinion of individuals in participating labs. We used Monte Carlo simulations to estimate the costs and the input parameters were modeled as distributions to incorporate the uncertainty. Total costs per sample including setup, overhead, and operational costs, range from $357-794 at a scale of 25 sites to $116-532 at 125 sites. Operational costs (ongoing expenditures) range from $218-584 per sample at a scale of 25 sites to $74-421 at 125 sites. Eleven of the thirteen protocols have operational costs below $200, at this higher scale. Protocols with higher up-front equipment costs benefit more from scale efficiencies and sensitivity analyses show that laboratory labor, processes, and consumables are the primary drivers of uncertainty. At scale, environmental surveillance for typhoid may be affordable (depending on the protocol, scale, and geographic context), though cost will need to be considered alongside future evaluations of test sensitivity. Opportunities to leverage existing infrastructure and multi-disease platforms may be necessary to further reduce costs.
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Affiliation(s)
- Brittany Hagedorn
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Nicolette A Zhou
- Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America
| | | | - Jeffry H Shirai
- Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America
| | - Jillian Gauld
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Yuke Wang
- Center of Global Safe Water, Sanitation, and Hygiene in the Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
| | - David S Boyle
- Diagnostics Program, PATH, Seattle, WA, United States of America
| | - John Scott Meschke
- Environmental and Occupational Health, University of Washington, Seattle, WA, United States of America
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7
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Martin J, Burns CC, Jorba J, Shulman LM, Macadam A, Klapsa D, Majumdar M, Bullows J, Frolov A, Mate R, Bujaki E, Castro CJ, Bullard K, Konz J, Hawes K, Gauld J, Blake IM, Mercer LD, Kurji F, Voorman A, Diop OM, Oberste MS, Modlin J, Macklin G, Eisenhawer M, Bandyopadhyay AS, Zipursky S. Genetic Characterization of Novel Oral Polio Vaccine Type 2 Viruses During Initial Use Phase Under Emergency Use Listing - Worldwide, March-October 2021. MMWR Morb Mortal Wkly Rep 2022; 71:786-790. [PMID: 35709073 DOI: 10.15585/mmwr.mm7124a2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The emergence and international spread of neurovirulent circulating vaccine-derived polioviruses (cVDPVs) across multiple countries in Africa and Asia in recent years pose a major challenge to the goal of eradicating all forms of polioviruses. Approximately 90% of all cVDPV outbreaks are caused by the type 2 strain of the Sabin vaccine, an oral live, attenuated vaccine; cVDPV outbreaks typically occur in areas of persistently low immunization coverage (1). A novel type 2 oral poliovirus vaccine (nOPV2), produced by genetic modification of the type 2 Sabin vaccine virus genome (2), was developed and evaluated through phase I and phase II clinical trials during 2017-2019. nOPV2 was demonstrated to be safe and well-tolerated, have noninferior immunogenicity, and have superior genetic stability compared with Sabin monovalent type 2 (as measured by preservation of the primary attenuation site [domain V in the 5' noncoding region] and significantly lower neurovirulence of fecally shed vaccine virus in transgenic mice) (3-5). These findings indicate that nOPV2 could be an important tool in reducing the risk for generating vaccine-derived polioviruses (VDPVs) and the risk for vaccine-associated paralytic poliomyelitis cases. Based on the favorable preclinical and clinical data, and the public health emergency of international concern generated by ongoing endemic wild poliovirus transmission and cVDPV type 2 outbreaks, the World Health Organization authorized nOPV2 for use under the Emergency Use Listing (EUL) pathway in November 2020, allowing for its first use for outbreak response in March 2021 (6). As required by the EUL process, among other EUL obligations, an extensive plan was developed and deployed for obtaining and monitoring nOPV2 isolates detected during acute flaccid paralysis (AFP) surveillance, environmental surveillance, adverse events after immunization surveillance, and targeted surveillance for adverse events of special interest (i.e., prespecified events that have the potential to be causally associated with the vaccine product), during outbreak response, as well as through planned field studies. Under this monitoring framework, data generated from whole-genome sequencing of nOPV2 isolates, alongside other virologic data for isolates from AFP and environmental surveillance systems, are reviewed by the genetic characterization subgroup of an nOPV working group of the Global Polio Eradication Initiative. Global nOPV2 genomic surveillance during March-October 2021 confirmed genetic stability of the primary attenuating site. Sequence data generated through this unprecedented global effort confirm the genetic stability of nOPV2 relative to Sabin 2 and suggest that nOPV2 will be an important tool in the eradication of poliomyelitis. nOPV2 surveillance should continue for the duration of the EUL.
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8
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Rigby J, Elmerhebi E, Diness Y, Mkwanda C, Tonthola K, Galloway H, Miles R, Henrion MYR, Edwards T, Gauld J, Msefula C, Johnston R, Nair S, Feasey N, Elviss NC. Optimized methods for detecting Salmonella Typhi in the environment using validated field sampling, culture and confirmatory molecular approaches. J Appl Microbiol 2021; 132:1503-1517. [PMID: 34324765 DOI: 10.1111/jam.15237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study evaluated detection methods for Salmonella Typhi (S. Typhi) in the environment, to establish a novel pathway from field sampling to isolation of viable organisms and molecular confirmation from complex environmental samples, thus enabling environmental surveillance of typhoid. METHODS AND RESULTS Multiple media were assessed using clinical isolates from the Public Health England's (PHE) Culture collection. The culture pathway selected consisted of a primary 2% bile broth and secondary Selenite F broth, followed by modified Chromogenic Agar for Salmonella Esterase (mCASE). A qPCR assay was adapted from a validated S. Typhi PCR panel for confirmation of isolates, with comparison to biochemical and serological tests showing good specificity. Sampling locations in Blantyre, Malawi were used to compare sampling methods. Viable S. Typhi were isolated from a mixture of trap and grab river water samples on six occasions. CONCLUSIONS Culture of viable S. Typhi from environmental samples was possible using effective capture and culture techniques. SIGNIFICANCE AND IMPACT OF STUDY Whilst several studies have attempted to detect S. Typhi from the environment, this is the first successful attempt to isolate the organism from river water since the 1980s. Supplementing clinical data with environmental screening offers the potential for enhanced surveillance, which might inform interventions and assess vaccination programmes.
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Affiliation(s)
- Jonathan Rigby
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | | | - Yohane Diness
- Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | - Charity Mkwanda
- Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | - Katalina Tonthola
- Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | - Heather Galloway
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | - Rory Miles
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
| | - Marc Y R Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi
| | - Thomas Edwards
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jillian Gauld
- Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Chisomo Msefula
- Department of Microbiology, The College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rob Johnston
- National Infection Service, Public Health England, London, UK
| | - Satheesh Nair
- National Infection Service, Public Health England, London, UK
| | - Nicholas Feasey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool-Wellcome Research Programme, The College of Medicine, Blantyre, Malawi.,Department of Microbiology, The College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nicola C Elviss
- National Infection Service, Public Health England, London, UK
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9
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Andrews JR, Baker S, Marks F, Alsan M, Garrett D, Gellin BG, Saha SK, Qamar FN, Yousafzai MT, Bogoch II, Antillon M, Pitzer VE, Kim JH, John J, Gauld J, Mogasale V, Ryan ET, Luby SP, Lo NC. Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance. Lancet Infect Dis 2018; 19:e26-e30. [PMID: 30170987 DOI: 10.1016/s1473-3099(18)30350-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
Typhoid fever is an acute systemic infectious disease responsible for an estimated 12-20 million illnesses and over 150 000 deaths annually. In March, 2018, a new recommendation was issued by WHO for the programmatic use of typhoid conjugate vaccines in endemic countries. Health economic analyses of typhoid vaccines have informed funding decisions and national policies regarding vaccine rollout. However, by focusing only on averted typhoid cases and their associated costs, traditional cost-effectiveness analyses might underestimate crucial benefits of typhoid vaccination programmes, because the potential effect of typhoid vaccines on the treatment of patients with non-specific acute febrile illnesses is not considered. For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year. Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally. We propose that large-scale, more aggressive typhoid vaccination programmes-including catch-up campaigns in children up to 15 years of age, and vaccination in lower incidence settings-have the potential to reduce the overuse of antimicrobials and thereby reduce antimicrobial resistance in many bacterial pathogens. Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines.
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Affiliation(s)
- Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, UK; Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Marcella Alsan
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | | | - Samir K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Marina Antillon
- Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jong-Hoon Kim
- Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vittal Mogasale
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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10
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Jacquetin B, Hinoul P, Gauld J, Fatton B, Rosenthal C, Clavé H, Garbin O, Berrocal J, Villet R, Salet-Lizée D, Debodinance P, Cosson M. Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study. Int Urogynecol J 2013; 24:1679-86. [PMID: 23563891 DOI: 10.1007/s00192-013-2080-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/23/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. METHODS Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. RESULTS Of the 90 women enrolled in the study, 82 (91%) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <-1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79% and 87% respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90%, 88% and 84% at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5%) required re-intervention for prolapse, while a total of 14 patients (16%) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54%) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10%, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only. CONCLUSIONS Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up.
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Affiliation(s)
- B Jacquetin
- Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont-Ferrand, France,
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McIntosh I, Swanson V, Gauld J, Hirst M. [Survey of attitudes to air travel after terrorist events of September 2001]. Vertex 2004; 15:99-101. [PMID: 15243653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
An opportunistic questionnaire study of peoples attitudes to, commercial flying and their behavioural responses after the events of September 11 2001 in the USA. Cohorts drawn from people attending a series of educational lectures, a specific leisure time activity and a travel health clinic 6 months after the disasters. More people appeared to worry about air travel 6 months after Sept 11 2001 than in reports prior to this date and the worried seem to experience a greater intensity of anxiety.
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Affiliation(s)
- Ian McIntosh
- St. Ninians Travel Health Research Centre, Stirling, Scotland
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